MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE 1488 HD 3-CHIP CAMERA HEAD, C-MOUNT - INTERNATIONAL KIT; LAPAROSCOPE, GENERAL & PLASTIC SURGERY

Model Number	1488210105
Medical Device Problem Code	Optical Distortion (3000)
Health Effect - Clinical Codes	No Known Impact Or Consequence To Patient (2692); No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/05/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Additional information will be provided once the investigation has been completed.The device manufacturer date is not known at this time.However, should it become available it will be provided in future reports.
Event or Problem Description
It was reported that there was a blurry image.
Event or Problem Description
It was reported that there was a blurry image.
Additional Manufacturer Narrative
This complaint investigation was closed based on the device not received, therefore the reported failure mode was not confirmed.In the event that the device is received, the complaint will be reopened and the investigation will be updated with new results.The reported failure mode will be monitored for future reoccurrence.Alleged failure: blurry image probable root cause: cables, connectors, digital board, power supply, filter / fuse, ac inlet board, main board, transition board, fiber board, intermittence between transition board and ch connector, software, scope (see rsk10356 output ""visualization/image""), light source (see rsk10975 output ""white light""), camera head (sensor, sensor cable), coupler (dust on optics, scratched optics, broken / shifted lenses, focusing mechanism, endoclamp, zoom ring), 1488 & 1588 extension cable, intermittence while using rf devices (ex: valleylab), problem toggling light source or from camera head, connected monitors, leaking, use error.Poor grounding (e.G.""finger"" grounding tab connecting front and rear enclosure.Camera head connection from cable to transition board.).Electromagnetic interference (emi) from rf communication, hf surgical instruments, esd, or power surge.Manufacturing/ service nonconformity h3 other text : 81.

• Brand Name: 1488 HD 3-CHIP CAMERA HEAD, C-MOUNT - INTERNATIONAL KIT
• Common Device Name: LAPAROSCOPE, GENERAL & PLASTIC SURGERY
• Manufacturer (Section D): STRYKER ENDOSCOPY-SAN JOSE; 5900 optical court; san jose CA 95138
• MDR Report Key: 10317747
• Report Number: 0002936485-2020-00296
• Device Sequence Number: 19599286
• Product Code: GCJ
• UDI-Device Identifier: 07613327061055
• UDI-Public: 07613327061055
• Combination Product (Y/N): N
• Initial Reporter Country: EG
• PMA/510(K) Number: K132785
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 09/16/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: 1488210105
• Device Catalogue Number: 1488210105I
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 06/28/2020
• Supplement Date Received by Manufacturer: 06/28/2020
• Initial Report FDA Received Date: 07/23/2020
• Supplement Report FDA Received Date: 09/16/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1